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Herpes simplex virus (HSV) and varicella zoster virus (VZV) are alpha herpesviruses that establish life-long latent infection in neuronal ganglia after primary infection. Periodic reactivation of these viruses results in recurrent infections that can have significant impact on patients' quality of life. HSV commonly causes oral and genital mucocutaneous infections whereas VZV is responsible for varicella/chickenpox and herpes zoster/shingles, but cancer patients are at particularly higher risk of complications including disseminated and visceral infections due to impaired cell-mediated immunity. While diagnosis of more common HSV and/or VZV infections is frequently clinically based, immunocompromised hosts may have atypical skin presentation or visceral involvement. Thus, diagnostic confirmation using virus-specific tests such as polymerase chain reaction or immunohistochemical staining is crucial in some cases. Oral acyclovir, valacyclovir and famciclovir are usually used for mild to moderate infections and intravenous acyclovir is the drug of choice for severe or disseminated infections. Foscarnet can be used when acyclovir-resistance is confirmed or suspected. Pharmaceutical prophylaxis against HSV and/or VZV should be considered in high-risk cancers patients. Currently, there is no commercially available vaccine against HSV, but VZV vaccines are available to prevent varicella and zoster. [ABSTRACT FROM AUTHOR]

Invasive fungal diseases (IFDs) are common in patients with acute myeloid leukemia (AML), but no recent data on incidence without antifungal prophylaxis are available. We evaluated the incidence of IFDs in patients with AML undergoing induction chemotherapy at Stanford University Hospital from 2012 to 2017, for up to 12 weeks after induction. We also analyzed factors associated with IFD development. Thirty-six of 240 patients (13%) developed at least one proven or probable IFD. Seventy-eight percent of the proven or probable IFDs were due to Candida or Aspergillus species. Infection due to Fusarium and Mucorales was uncommon. Absolute neutrophil count (ANC) of <500 µL/L at the start of induction was associated with an increased risk of IFD. One hundred and eighty-seven patients (78%) were started on systemic antifungal drugs, even without microbiologic evidence of an IFD. IFDs remain frequent in AML patients undergoing induction chemotherapy without antifungal prophylaxis. [ABSTRACT FROM AUTHOR]

Over the last decade, the therapeutic landscape for hematological malignancies (HMs) has witnessed a remarkable surge in the development of novel biological and small‐molecule‐targeted immunomodulatory agents. These therapies have drastically improved survival, but some come at the cost of increased risk of bacterial, viral, and/or fungal infections and on‐target off‐tumor immunological side effects. To mitigate such risks, physicians must be well informed about infectious complications and necessary preventive measures, such as screening, vaccinations, and antimicrobial prophylaxis. Furthermore, physicians should be vigilant about the noninfectious side effects of these agents that can mimic infections and understand their potential drug–drug interactions with antimicrobials. Strengthening and harmonizing the current surveillance and reporting system for drug‐associated infections in real‐world settings is essential to better ascertain the potential infections associated with these agents. In this review, we aimed to summarize the infection risks associated with novel agents used for specific HMs and outline recommended strategies for monitoring and prophylaxis. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to offer a theoretical discussion on teacher leadership in early childhood education (ECE) in Chinese contexts. Since 2010, the Chinese government has initiated a comprehensive education reform in ECE, with strategies for developing teacher leadership and promoting education quality. However, at the school level there is a lack of leadership preparation and development, along with a gap between policy initiative and its implementation. How to narrow this gap between policy and practice in teacher leadership has become a critical issue for ECE in China. This paper suggests that 'formal role or informal role' and 'role or practice' are important dimensions of teacher leadership in a Chinese, policy-driven context. In this regard, it is worth exploring how teacher leadership is conceptualized and enacted in the process of quality improvement and related contextual factors. In doing so, an agenda could be identified for future research, contributing to theories on the development of teacher leadership in the global discourse. [ABSTRACT FROM AUTHOR]

In recent years, the role of school principals in providing leadership, and the impact of that leadership in promoting teacher professional development for building school capacity has attracted increasing attention worldwide. The study described in this paper explores the practices of leadership for promoting school-based teacher professional development (SBTPD) through a case study of a preschool in Hong Kong, the Special Administrative Region of China. The case study examines leadership and SBTPD. Semi-structured interviews were used for data collection. The research participants were the management team and teachers from the case study school. The findings of the study indicate that direction setting, communication and collaboration were associated with the practice of leadership for promoting SBTPD. We argue that teacher participation in decision-making is an important factor influencing the practice of leadership and its impact on SBTPD. There are implications for developing a critical awareness of the constraints that limit the extent to which SBTPD can be empowering in the hierarchical school structure in a Chinese educational context. [ABSTRACT FROM PUBLISHER]

This article offers a theoretical discussion on the current problems and future challenges of school capacity building in early childhood education (ECE), aiming to highlight some key areas for future research. In recent years, there has been a notable policy shift from monitoring quality through inspection to improving quality through school capacity building in early childhood institutions in the global discourse for quality. Reflecting this policy shift and its implications on school development, ECE in Hong Kong is used as an illustrative example to deliberate the issues of school capacity building in Chinese educational contexts. We identify three challenging contexts: (1) low professional qualification and minimal teacher education resulting in a deficit approach to processional development, (2) absence of school-based professional learning culture for empowering teachers as internal agents of change, and (3) hierarchical culture within a school and between university and school hindering the process of school capacity building. Corresponding to these challenges, we aim to propose two suggestions, including (1) empowering teachers in ECE through school-based professional learning community and (2) promoting authentic external support in the process of university–school collaboration. Finally, we further propose specific directions for future research on school capacity building in ECE in Hong Kong. In doing so, it will contribute to knowledge-based development in school capacity building in Chinese educational contexts. [ABSTRACT FROM PUBLISHER]

This study explores the relationship between school-level teacher qualifications and school-based professional learning community (PLC) practices in Early Childhood Education in Hong Kong. A territory-wide survey examined how preschool teachers perceived shared responsibility, reflective dialogues, deprivatized practices and organizational learning. The findings suggest a significant relationship between school-level teacher qualifications and teachers' perceptions of school-based PLC practices. As the percentage of bachelor degree holders in preschools increases, teachers are more positive about PLC practices in their perceptions. This study establishes a platform for future studies focusing on structural relationships between teacher qualifications and school-based PLC practices. [ABSTRACT FROM AUTHOR]

This paper describes the process of school capacity building in Hong Kong's early childhood education at a time when there was a quest for quality education. A local preschool was selected for the study, which took part in a university–school support programme through which consultancy was hired from a university to provide school-based support. An action research approach was chosen in the research design. The process of building capacity was examined in the selected preschool over a year. The findings indicated that the preschool went through a process of capacity building, from thestatus quo ante, through the exploration stage to the initial implementation stage of change. Restructuring and reculturing were emerging in the change process, with the support of the school consultants. [ABSTRACT FROM PUBLISHER]

In 2007, the Government of Hong Kong implemented the Pre-primary Education Voucher Scheme to provide allowances for parents to purchase services in local preschools. The scheme includes the policy for subsidising the professional development of preschool teachers, which aims at upgrading their professional qualifications in five years, thereby improving teaching quality. This paper explores whether there is a gap between the policy objectives and teacher professional development through case studies at a time when the education reform has been implemented. Semi-structured interviews were used for data collection. The participants had some views in common about the positive aspects of the professional development policy. However, the findings also indicate that preschool teachers have a passive attitude toward learning, which might have an adverse influence on their lifelong professional development. The implications for the professional development policy and teacher professional development are discussed. [ABSTRACT FROM AUTHOR]

In recent years, the Western discourse on distributed leadership has attracted increased attention in Chinese societies that have traditionally relied on highly centralized administrative systems in which power is located in the person of the school principal or other unit leader. This article explores the implications of applying the concept of distributed leadership in a Chinese context and outlines a research agenda for future work in this area. The article focuses specifically on teacher leadership in early childhood education in Hong Kong as an illustrative case. It suggests that change agentry, collaboration, collegiality, power, and authority are key aspects of discourse on teacher leadership in a Chinese, policy-driven context. It is argued that existing studies of leadership have failed to recognize the complexity of employing teacher leadership in hierarchical, policy-driven, high power distance, collectivist cultural contexts. [ABSTRACT FROM AUTHOR]

The article discusses South Korean popular music, or K-pop groups, such as SHINee, TVXQ, and 2 PM, their popularity among teenagers in the U.S., and ways for libraries to provide information and materials about K-pop. Also mentioned are Korean television dramas such as "Shut Up Flower Boy Band," the founding of entertainment agency SM Entertainment by Lee Soo Man in the 1990s, and library programming for fans of K-pop. The author describes K-pop programs at the Los Angeles Public Library (LAPL) in California, and provides lists of male and female K-pop bands and online resources for K-pop culture such as the websites www.allkpop.com, www.dkpopnews.net, and www.freegalmusic.com.

Western frameworks for school improvement, including the stakeholder model and the model of decentralized leadership, have recently been promoted as solutions for school improvement. Using early childhood education in Hong Kong as an illustrative case, this article focuses on the power and authority of leadership in school decision making. The interview data collected from the two case study schools reveal a paradox of power in leadership that is characterized by tensions between centralization and decentralization in the change process, where decentralization is advocated by policymakers but traditional hierarchical cultures remain. The relationship between the leaders and school stakeholders incorporates a concept of harmony that functions to defuse the potential power struggle embedded in decision making. [ABSTRACT FROM PUBLISHER]

Haematological patients with neutropenic fever are frequently evaluated with chest computed tomography (CT) to rule out invasive fungal infections (IFI). We retrospectively analysed data from 100 consecutive patients with neutropenic fever and abnormal chest CT from 1998 to 2005 to evaluate their chest CT findings and the yield of diagnostic approaches employed. For their initial CTs, 79% had nodular opacities, with 24.1% associated with the halo sign. Other common CT abnormalities included pleural effusions (48%), ground glass opacities (37%) and consolidation (31%). The CT findings led to a change in antifungal therapy in 54% of the patients. Fifty-six patients received diagnostic procedures, including 46 bronchoscopies, 25 lung biopsies and seven sinus biopsies, with a diagnostic yield for IFI of 12.8%, 35.0% and 83.3%, respectively. In conclusion, chest CT plays an important role in the evaluation of haematological patients with febrile neutropenia and often leads to a change in antimicrobial therapy. Pulmonary nodules are the most common radiological abnormality. Sinus or lung biopsies have a high-diagnostic yield for IFI as compared to bronchoscopy. Patients with IFI may not have sinus/chest symptoms, and thus, clinicians should have a low threshold for performing sinus/chest imaging, and if indicated and safe, a biopsy of the abnormal areas. [ABSTRACT FROM AUTHOR]

With a growing awareness of the importance of early childhood education, the governments of Hong Kong and England have both increased investment through providing fee assistance to parents for buying services and providing funding to providers for offering 'free' places, respectively. Alongside the increased funding of early childhood education, a heightened interest in the quality of early years settings has arisen. This paper aims to develop a framework for comparative studies by addressing the similarities and differences in quality improvement of both systems. Three key issues are discussed: relevance of the quality criteria for assessment, interpretations of the quality improvement mechanism and its use in guiding practice, and the influence of contextual factors in terms of stakeholders' views of the quality process. It is argued that these key issues are fundamental to a framework for understanding different sociocultural contexts and dynamics in shaping the quality improvement of early childhood education. [ABSTRACT FROM AUTHOR]

Disseminated Fusarium infection can cause significant morbidity and mortality in immunocompromised patients. We present a case of disseminated fusariosis in a patient with neutropenic fever successfully treated using both liposomal amphotericin B and voriconazole. Combination anti-fungal therapy may be considered for such patients, particularly for those failing single-drug therapy. [ABSTRACT FROM AUTHOR]

Background Neuroinvasive infection with Francisella tularensis , the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection. Methods We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950. Results One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable. Conclusions Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment. [ABSTRACT FROM AUTHOR]

Solid organ transplant recipients are at risk for infectious complications due to chronic immunosuppression. The outbreak of coronavirus disease 2019 (COVID‐19) in the United States has raised growing concerns for the transplant patient population. We seek to add to the current limited literature on COVID‐19 in transplant recipients by describing the clinical course of two kidney transplant recipients with SARS‐CoV‐2 infection monitored by both RT‐PCR and serology. Through careful adjustment of their immunosuppression regimen, both patients had excellent recovery with intact graft function and development of anti‐SARS‐CoV‐2 antibodies. [ABSTRACT FROM AUTHOR]

In this study, we aimed to explore early childhood educators' conceptualisations of physical literacy and how these are integrated in their teaching practice. To this end, we used a mixed-methods embedded design, with a primarily qualitative component that is supported by quantitative data (QUAL + quan). Participants consisted of class teachers (n = 26), head teachers (n = 8), and principals (n = 11), who participated in interviews and responded to questionnaires. Qualitative data were examined using thematic analysis, and quantitative data were analysed using non-parametric statistics. Early childhood educators articulated an incomplete conceptualisation of physical literacy and reported low awareness of the concept. While the concept is relatively novel to early childhood teachers, integration of physical literacy in teaching practice was found to encompass the inter-related physical, affective, cognitive, and behavioural domains. Availability of resources, teacher training, education policies, family environment, and community environment were found to influence the development of physical literacy in early childhood settings. We recommend that education policies be reviewed, and systems-based support be provided to enhance teachers' capabilities, as well as family and community environments. [ABSTRACT FROM AUTHOR]

This article discusses a case of erythema gyratum repens (EGR), a dermatologic condition, associated with pulmonary tuberculosis (TB). EGR is typically linked to underlying malignancy, but in this case, TB was identified as the trigger. The patient, an immigrant from the Philippines, presented with skin lesions and other symptoms, but TB was initially overlooked due to a negative test result. The article emphasizes the importance of considering alternative causes of EGR and highlights the need for further testing in high-risk patients, regardless of test results. [Extracted from the article]

Background: Skull base osteomyelitis (SBO) is an infection of the central cranial bones, most commonly resulting from contiguous spread of infection from adjacent head and neck structures. SBO is a well‐recognized complication of treatment of head and neck cancer (HNC) that results in significant morbidity. Methods: We conducted a retrospective chart review of HNC patients diagnosed with SBO. Results: SBO was commonly diagnosed with nasal endoscopy showing mucosal breakdown between the naso/oropharynx and skull base and with characteristic changes on CT/MRI. Culture data were often polymicrobial, inclusive of naso/oropharyngeal flora, but half of the patients additionally had antibiotic‐resistant or atypical pathogens. The mean duration of antimicrobial therapy was 117 +/− 94 days. Recurrent SBO was found in half of the patients, associated with Pseudomonas aeruginosa and with persistent defects in the mucosa abutting the skull base. Conclusions: Diagnosis and management of SBO in HNC patients are challenging. Recommendations to aid in clinical care are proposed. Level of evidence: 4, case series. [ABSTRACT FROM AUTHOR]

Background Invasive fungal infection (IFI) is a growing cause of morbidity and mortality in oncology and transplant patients. Diagnosis of IFI is often delayed due to need for invasive biopsy and low sensitivity of conventional diagnostic methods. Fungal cell-free DNA (cfDNA) detection in plasma is a novel testing modality for the noninvasive diagnosis of IFI. Methods A novel bioinformatic pipeline was created to interrogate fungal genomes and identify multicopy sequences for cfDNA polymerase chain reaction (PCR) targeting. A real-time PCR panel was developed for 12 genera and species most commonly causing IFI. Sensitivity and specificity of the fungal PCR panel were determined using plasma samples from patients with IFI and non-IFI controls. Clinical impact of the fungal PCR panel was evaluated prospectively based on the treating team's interpretation of the results. Results Overall, the sensitivity and specificity were 56.5% (65/115; 95% confidence interval [CI], 47.4–65.2) and 99.5% (2064/2075; 95% CI, 99.0–99.7), respectively. In the subset of patients with an optimized plasma volume (2 mL), sensitivity was 69.6% (48/69; 95% CI, 57.9–79.2). Sensitivity was 91.7% (11/12; 95% CI, 62.5–100) for detection of Mucorales agents, 56.3% (9/16; 95% CI, 33.2–76.9) for Aspergillus species, and 84.6% (11/13; 95% CI, 56.5–96.9) for Candida albicans. In a prospective evaluation of 226 patients with suspected IFI, cfDNA testing was positive in 47 (20.8%) patients and resulted in a positive impact on clinical management in 20 of 47 (42.6%). Conclusions The fungal cfDNA PCR panel offers a noninvasive approach to early diagnosis of IFI, providing actionable results for personalized care. [ABSTRACT FROM AUTHOR]

This paper discusses the changing concepts of leadership in early childhood education (ECE) in England and Hong Kong during a period of significant education reform. We seek to illustrate the interplay between the impact of the policy agenda and the emerging quality leadership perspectives found in the theoretical literature, by first considering the recent education reform context in both England and Hong Kong, before examining the importance of leadership for quality provision given the constraints and drivers of policy expectation. The paper explores transformational, distributed and authentic models of leadership in the ‘New Leadership’ paradigm and uses these constructions to examine the developing problems and opportunities for quality leadership as expected by the current policy reform agenda and understood by the practitioners. In conclusion, we raise questions about the interplay between policy agendas and the development of theoretical models of leadership for ECE in England and Hong Kong. [ABSTRACT FROM AUTHOR]

Infection because of herpes simplex virus (HSV) that is resistant to acyclovir (ACV) poses treatment challenges in hematopoietic cell transplant (HCT) patients. We present a series of patients with ACV-resistant HSV following HCT who were successfully treated with continuous infusion high-dose ACV after failing standard treatment regimens for ACV-resistant HSV. [ABSTRACT FROM AUTHOR]

Background:  Patients with lymphoproliferative disorders following hematopoietic stem cell transplant (HSCT) most commonly present with fever and lymphadenopathy within the first 5 months of transplant. Pulmonary post-transplant lymphoproliferative disorder (PTLD) is a particularly aggressive and rapidly progressive disease, with high morbidity and mortality. There are a very limited number of reported pulmonary PTLD cases following HSCT in patients with acute myeloid leukemia (AML). Early diagnosis and detection of pulmonary PTLD is critical given its high lethality. However, variable clinical presentations and nonspecific radiographic findings make pulmonary PTLD difficult to distinguish from other more common causes of pulmonary disease in AML patients.Case Presentation: Here, we describe a 68-year-old Caucasian man who presented for salvage induction therapy following relapse of his AML after a haploidentical allogeneic HSCT 10 months earlier. He developed recurrent fevers, dry cough, and hypoxemia, with chest computed tomography (CT) showing bibasilar consolidations and increased nodularity without increased lymphadenopathy. His symptoms initially improved with antibiotic and antifungal therapy, but his follow-up chest CT showed progression of disease despite symptomatic improvement. Epstein-Barr virus (EBV) was detected in his blood by polymerase chain reaction (PCR), and a lung biopsy revealed monomorphic PTLD with B cells positive for EBV. Unfortunately, the patient's condition rapidly deteriorated, and he passed away prior to treatment initiation.Conclusions:  To our knowledge, this is the first reported case of an AML patient developing pulmonary PTLD relatively late in his post-transplant course in the setting of relapsed disease and salvage therapy. Pulmonary PTLD, a rare but highly lethal disorder, can imitate the symptoms and radiographic findings of pneumonia, a common diagnosis in immunocompromised AML patients. This case illustrates the importance of considering pulmonary PTLD in the differential diagnosis for pulmonary disease in AML patients with a history of HSCT, especially in the setting of progressive radiographic findings despite broad antibacterial and antifungal therapy. Further, our case demonstrates the importance of biopsy and uninterrupted EBV DNA monitoring in the definitive diagnosis of PTLD, given nonspecific symptomatology and radiographic findings. [ABSTRACT FROM AUTHOR]

Advances in solid organ transplantation have improved the survival of end‐stage organ disease at the expense of an increased risk for opportunistic infections. Unusual clinical presentations and the possibility of concurrent infections make diagnosing invasive fungal infection (IFI) more difficult. Here, we present a case of simultaneous vertebral infection caused by Coccidioides immitis‐posadasii and subcutaneous phaeohyphomycosis due to Nigrograna mackinnonii in a kidney transplant recipient. The diagnosis of both infections required invasive procedures to obtain tissue and a high index of suspicion that more than one IFI could be present. A multidisciplinary team approach for the management of immunocompromised patients with suspected or diagnosed IFI is warranted. [ABSTRACT FROM AUTHOR]

The article discusses the inter-relationship between effective leadership and quality improvement of early childhood education and care (ECEC) in England and Hong Kong, China. It mentions that Hong Kong developed a voucher system for pre-primary education while England gave a school grant for children including those in deprived areas. It says that the Office for Standards in Education (OFSTED) is responsible for the inspection and regulation of educational services in England and in the development of the early years foundation stage (EYFS). Moreover, Hong Kong has adopted a different approach to quality which involves school's self-evaluation under the Quality Review Framework.

Cytomegalovirus (CMV) reactivation is common in organ transplant recipients and can lead to significant morbidity and mortality. Cutaneous CMV findings are rarely reported in the literature and diagnosis can be delayed if not clinically recognized. We describe a case of a female patient 20 years post renal transplant who presented with extensive ulcerative skin lesions and diarrhea. She rapidly deteriorated and died on day 5 of hospitalization. Autopsy noted extensive CMV involvement of skin and gastrointestinal (GI) tract by CMV‐specific immunohistochemistry. These findings, along with high‐grade CMV viremia, led to the final postmortem diagnosis of disseminated CMV infection. This case focuses on the cutaneous findings of disseminated CMV as recognition of CMV skin lesions can lead to earlier initiation of appropriate therapy in transplant recipients. [ABSTRACT FROM AUTHOR]

Abstract: Infection with Scedosporium species is associated with a significant morbidity and mortality and is becoming increasingly common, especially in immunocompromised patients. We describe the presentation and successful management of an immunocompromised patient with Scedosporium apiospermum infection of the upper urinary tract system, a rare disease manifestation. The current literature on urinary tract scedosporiosis is further reviewed with emphasis on treatment options and limitations of current antifungal therapy. [ABSTRACT FROM AUTHOR]

We report a fatal case of disseminated Emmonsia sp. infection in a 55-year-old man who received an orthotopic liver transplant. The patient had pneumonia and fungemia, and multisystem organ failure developed. As human habitats and the number of immunocompromised patients increase, physicians must be aware of this emerging fungal infection. [ABSTRACT FROM AUTHOR]

Background. Endocarditis is a rare manifestation of infection with Coccidioides. This is the first reported case of donor-derived Coccidioides endocarditis obtained from a heart transplant. Methods. We present a unique case of donor-derived Coccidioides immitis endocarditis and disseminated infection in a heart transplant patient. We also conducted a review of the literature to identify other cases of donor-derived coccidioidomycosis in solid organ transplant recipients and reviewed their clinical characteristics. Results. Fifteen prior cases of donor-derived coccidioidomycosis were identified. A majority of these cases were diagnosed by positive culture (83%). Mortality was high at 58%. Conclusions. Clinicians should maintain a high index of suspicion for disseminated coccidioidomycosis in patients who received transplants with organs from donors with a history of residing in endemic regions. [ABSTRACT FROM AUTHOR]

The reconstitution of immune function after hematopoietic cell transplant (HCT) plays an important role in the control of viral infections. Both donor and recipient cytomegalovirus (CMV) serostatus has been shown to contribute to effective immune function; however, the influence of a nonmyeloablative preparative (NMA) regimen using total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) on antiviral immune reconstitution has not yet been described. In 117 recipients of NMA HCT patients following ATG and TLI, not unexpectedly, CMV viremia was seen in approximately 60% of the seropositive patients regardless of donor serostatus, and recipient seropositivity significantly increased the odds of CMV viremia after transplant in a multivariate analysis. The administration of ATG and TLI resulted in a strikingly earlier viremia in the posttransplant period when compared to the previously reported timing of viremia following myeloablative preparative regimens, especially for transplant recipients who were seropositive for CMV with seronegative donors. Furthermore, early viremia in the setting of a CMV naïve donor was associated with a delay in functional antiviral control. These observations demonstrate the dynamic nature of immunity in relation to CMV antigen exposure in the complex environment resulting from NMA conditions where both donor and residual recipient immune response affect viral control. [Copyright &y& Elsevier]

Abstract: Dosage-sparing strategies, adjuvants and alternative substrates for vaccine production are being explored for influenza vaccine development. We assessed the safety and immunogenicity of a Vero cell culture-grown inactivated whole virus influenza A/H5N1 vaccine with or without aluminum hydroxide adjuvant [Al(OH)3] in healthy young adults. Vaccines were well tolerated, but injection site discomfort was more frequent in groups receiving Al(OH)3. Dose-related increases in serum antibody levels were observed. Neutralizing antibody titers varied significantly when tested by two different laboratories. Al(OH)3 did not enhance HAI or neutralizing antibody responses, and contributed to increased injection site pain. Because influenza antibody titers vary significantly between different laboratories, international standardization of assays is warranted. [Copyright &y& Elsevier]

Abstract: To augment the available influenza vaccine supply, a phase III study was conducted to evaluate the immunogenicity, safety, and consistency of a new trivalent inactivated influenza vaccine manufactured by CSL Limited. Healthy adults (ages 18–64) were randomized to receive either a single dose of TIV from multi-dose vials with thimerosal, TIV from pre-filled syringes without thimerosal, or placebo. Of the TIV recipients, 97.8% achieved a post-vaccination titer ≥40 against H1N1, 99.9% against H3N2 component, and 94.2% against influenza B. Few local or systemic adverse events were noted after vaccination with either TIV presentation. TIV was well tolerated and immunogenic. [Copyright &y& Elsevier]

Background While invasive fungal infections (IFIs) are common in patients with acute myeloid leukemia (AML) undergoing induction chemotherapy, little current data exist on the epidemiology of IFIs in this patient population given widespread use of antifungal prophylaxis. Because our institution does not administer antifungal prophylaxis, we are in a unique position to study the natural history of IFIs in these patients. Methods We evaluated the incidence of IFIs using established definitions in adults with AML undergoing induction chemotherapy at Stanford Health Care from 2012 to 2017. We also analyzed incidence of antifungal treatment, impact of IFI diagnosis on survival, and risk factors for IFI development. Patients were followed for up to 12 weeks after beginning induction chemotherapy. Results Of 488 patients analyzed, 243 were eligible for inclusion. The median age was 57 (interquartile range 45–65). Men composed 134 (55%) of the patients and 157 (65%) where white. Fifty-four (22%) had antecedent myelodysplastic syndrome; most received a "7 + 3" regimen involving cytarabine and an anthracycline. Thirty-one (13%) developed a proven or probable IFI; 104 (43%) developed a proven, probable, or possible IFI. Most IFIs were due to lower respiratory tract disease. Eighteen identified organisms were Candida, including six C. albicans. Eight organisms were mold, including four Aspergillus isolates (all but one A. fumigatus) and one isolate each of Fusarium solani , Rhizomucor , Rhizopus , and Scedosporium apiospermum / Pseudallescheria boydii. One hundred ninety patients (78%) received antifungals during their initial admission and 99 (46%) of patients surviving their initial admission were discharged on antifungals. Only 66.7% of patients with a proven or probable IFI survived through 12 weeks, compared with 92.2% of those without (P = 0.007). Baseline absolute neutrophil count ≤500 cells/μL and longer duration of neutropenia were significantly associated with development of proven or probable IFIs. Conclusion Among patients receiving induction chemotherapy for AML, IFIs due to Candida and mold remain frequent absent antifungal prophylaxis and are associated with worse survival. Our findings support the use of antifungal prophylaxis in this patient population. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Abstract Necrotic insults such as seizure are excitotoxic. Logically, membrane hyperpolarization by increasing outwardly conducting potassium channel currents should attenuate hyperexcitation and enhance neuron survival. Therefore, we overexpressed a small-conductance calcium-activated (SK2) or voltage-gated (Kv1.1) channel via viral vectors in cultured hippocampal neurons. We found that SK2 or Kv1.1 protected not only against kainate or glutamate excitotoxicity but also increased survival after sodium cyanide or staurosporine. In vivo overexpression of either channel in dentate gyrus reduced kainate-induced CA3 lesions. In hippocampal slices, the kainate-induced increase in granule cell excitability was reduced by overexpression of either channel, suggesting that these channels exert their protective effects during hyperexcitation. It is also important to understand any functional disturbances created by transgene overexpression alone. In the absence of insult, overexpression of Kv1.1, but not SK2, reduced baseline excitability in dentate gyrus granule cells. Furthermore, while no behavioral disturbances during spatial acquisition in the Morris water maze were observed with overexpression of either channel, animals overexpressing SK2, but not Kv1.1, exhibited a memory deficit post-training. This difference raises the possibility that the means by which these channel subtypes protect may differ. With further development, potassium channel vectors may be an effective pre-emptive strategy against necrotic insults. [ABSTRACT FROM AUTHOR]

Increases in cytoplasmic Ca2+ concentration ([Ca2+]i) can lead to neuron death. Preventing a rise in [Ca2+]i by removing Ca2+ from the extracellular space or by adding Ca2+ chelators to the cytosol of target cells ameliorates the neurotoxicity associated with [Ca2+]i increases. Another potential route of decreasing the neurotoxic impact of Ca2+ is to overexpress one of the large number of constitutive calcium-binding proteins. Previous studies in this laboratory demonstrated that overexpression of the gene for the calcium-binding protein calbindin D28K, via herpes simplex virus (HSV) amplicon vector, increases the survival of hippocampal neurons in vitro following energetic or excitotoxic insults but not following application of sodium cyanide. We now report that in vivo hippocampal infection with the calbindin D28K HSV vector increases neuronal survival in the dentate gyrus after application of the antimetabolite 3-acetylpyridine and increases transsynaptic neuronal survival in area CA3 following kainic acid neurotoxicity. The protective effects of infection with the calbindin D28K vector in an intact brain may prove to be beneficial during changes in Ca2+ homeostasis caused by neurological trauma associated with aging and certain neurological diseases. [ABSTRACT FROM AUTHOR]

The article presents a study related to the use of Fluoroquinolones drug for tuberculosis prophylaxis in liver transplant patients. Topics discussed include treatment of latent tuberculosis prior to liver transplant, tuberculosis interferon-gamma-release-assays, and association of levofloxacin drug to tendinitis and tendon rupture.